Wetlands Violation - Initial Complaint Form

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Wetlands Violation - Initial Complaint Form

1. Complainant

Name:

Address:

Phone #:

2. Location of Suspected
Violation

Street:

Town:

State:

What is the nearest intersection, street, waterbody
or other landmark?

3. The Activity

a)

Is there a discharge of dredged
and/or fill material into wetlands or waters?

Yes
NO

b)

Is the activity ongoing?

Yes
NO

c)

What is the approximate area
of filled wetlands or waters?

acres or
square feet

d)

Is mechanized landclearing
taking place?

Yes
NO

e)

If the answer to d) is yes,
what is the approximate area of land that
has been cleared through mechanized landclearing?

acres or
square feet

f)

When did the activity begin?

4. The Parties Involved

a) Landowner's

Name:

Address:

Phone #:

b) Contractor's

Name:

Address:

Phone #:

5. Other Information

a) Do you know if local, state or other federal
authorities are involved? If yes, explain:

b) Do you have maps, photographs and/or names
of other individuals who might have additional
information?

6. Other Comments

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